Comparison of Irinotecan/carboplatin versus Etoposide/carboplatin for extended disease small cell lung cancer (ED-SCLC): A systematic review and meta-analysis of randomized controlled trials

Abstract

Background Platinum-based chemotherapy in addition to the non-platinum agent Etoposide is the standard of care for ES-SCLC. However, the front-line chemotherapy regimen is not known. Therefore, we aimed to perform this review comparing irinotecan/carboplatin and etoposide/carboplatin in the patients of ED-SCLC. Methods We searched three databases i.e. PubMed, Embase and Cochrane library. We evaluated the outcomes for complete response, median overall survival, and progression free survival. In addition to that adverse events such as leukopenia, thrombocytopenia, anemia, diarrhea, and infections were also assessed. RevMan 5.4.1 was used to perform the statistical analysis. Results Three RCTs with 676 patients were included. There was a significant difference among IC and EC arms in terms of complete response (RR 2.52; 95% CI 1.20–5.32; p = 0.02, I2 = 0%), Leukopenia (RR = 0.47; 95% CI 0.23 to 0.97; P = 0.04; I2 = 90%), Anemia (RR = 0.55; 95% CI 0.38 to 0.78; P = 0.0008; I2 = 0%), Thrombocytopenia (RR = 0.51; 95% CI 0.39 to 0.68; P = 0.00001; I2 = 0%); and Diarrhea (RR = 4.88; 95%CI 1.64 to 14.49; P = 0.004; I2 = 33%). There was no statistically significant difference among IC and EC arms in terms of Median Overall survival (HR = 1.16; 95%CI 0.84 to 1.62; P = 0.37; I2 = 74%), Progression-free survival (HR = 1.04; 95% CI 0.69 to 1.56; P = 0.85; I2 = 77%), Nausea (RR = 1.70; 95%CI 0.76 to 3.81; P = 0.19; I2 = 0%), Infection (RR = 0.97; 95%CI 0.64 to 1.48; P = 0.89; I2 = 0%) and Treatment-related Deaths (RR = 0.58; 95%CI 0.24 to 1.42; P = 0.23; I2 = 0%). Conclusions In conclusion, this meta-analysis provides valuable evidence supporting the superiority of IC regimens over EC regimens in terms of complete response and toxicity profile for ED-SCLC.